Clinical Research Directory

Prediction of Postdural Puncture Headache

The primary objective of this study is to evaluate the effectiveness of inflammation index (pan-immune inflammation value, systemic immune inflammation index, and systemic inflammatory response index) values, calculated from routine pre- and post-operative blood test (hemogram) results of pregnant women undergoing cesarean section under spinal anesthesia, in predicting postdural puncture headache. Significant results will allow for the early identification of the population at risk of developing PPH and the implementation of preventive measures. The secondary objectives of the study are to evaluate the effects of factors such as demographic data (age, height, weight, and body mass index) obtained from patient records and the hospital information system, number of births, blood group, infant birth weight, smoking, previous history of postdural puncture headache (PPH), or headache in general, on the development of postdural puncture headache (PPH), to determine the frequency of PPH, and to identify the symptoms accompanying PPH.

Comparison of Post-Dural Puncture Headache After Spinal Anesthesia Using Median Versus Paramedian Approach

This randomized controlled trial will compare two commonly used techniques for performing spinal anesthesia, the median (midline) approach and the paramedian (lateral) approach, in adult patients undergoing elective orthopedic or urology surgery at Mayo Hospital, Lahore. Spinal anesthesia is widely used because it provides rapid pain control during surgery and avoids airway instrumentation. However, a recognized complication is post-dural puncture headache (PDPH), a headache that typically worsens on sitting or standing and improves on lying down. PDPH can delay mobilization, reduce oral intake, prolong hospital stay, and sometimes require additional treatment. Eligible participants aged 18 to 65 years with American Society of Anesthesiologists (ASA) physical status I or II will be enrolled, and then allocated in a 1:1 ratio to receive spinal anesthesia using either the median or paramedian approach. To standardize the procedure, spinal anesthesia will be performed under aseptic technique at the L3 to L4 or L4 to L5 interspace using a 25-gauge Quincke spinal needle, followed by injection of a fixed dose of hyperbaric bupivacaine. Routine perioperative monitoring will be applied for all participants, and intra-operative blood pressure will be recorded at regular intervals to document hypotension. The primary outcomes are the frequency and severity of PDPH. PDPH will be assessed using a structured checklist based on the International Classification of Headache Disorders, 3rd edition (ICHD-3) at 24 hours, 72 hours, and day 5 after the procedure by a trained assessor. Headache intensity will be recorded using a 0 to 10 Visual Analogue Scale, and categorized as mild, moderate, or severe. The hypothesis is that the frequency and severity of PDPH differ between the median and paramedian approaches in patients receiving spinal anesthesia for orthopedic or urology surgery.